Male slings for postprostatectomy incontinence

Abstract

Purpose: Over the past few years, there has been increasing interest in using male slings for postprostatectomy incontinence (PPI). Currently, three different forms of the male sling has been described: one using synthetic materials and two using human fascia or dermis. This article will give a historical perspective on the male sling and describe the surgical techniques and early results using two different types of male slings using fascia or dermis.

Materials and methods: From 1997 to 1999, nine patients with PPI underwent a bladder neck sling procedure using a combined perineal and abdominal approach. All patients had a suprapubic incision to expose the rectus muscle and to place a suprapubic tube. Since 1999, we have used a wide cadaveric fascial or dermal sling placed at the proximal bulbar urethra. Using an entirely perineal approach, the sling ends are fixated to the inferior pubic rami using bone anchors.

Results: Of 9 patients with bladder neck slings, 6 are dry, 1 is significantly improved, and 2 have failed, at a mean follow-up of 13 months. For the perineal male sling, 26 (45%) of 58 patients were completely dry, and overall 47 (81%) of 58 were significantly improved or were dry at a mean 6 months postoperatively. Neither group had significant complications.

Conclusions: Both male slings appear to be safe and effective procedures for treating PPI; however, longer follow-up and additional experience are needed to determine their true role in the treatment of PPI.